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Diagnostic Yield of Routine Enteropathogenic Stool Tests in Pediatric Ulcerative Colitis
Faith D Ihekweazu1, Avanthi Ajjarapu2, Richard Kellermayer2
1Section of Pediatric Gastroenterology, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Texas Children's Hospital, Houston, TX, USA faith.ihekweazu@bcm.edu.
Insights
Routine stool testing for Clostridium difficile infection is recommended in pediatric ulcerative colitis (UC) flares. Other infectious stool studies are less common but may be relevant in select cases.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Inflammatory Bowel Disease
Background:
- Excluding infectious etiologies is crucial before altering immunosuppressive therapy in ulcerative colitis (UC) exacerbations.
- Diagnostic yield of routine infectious stool studies in pediatric UC patients requires evaluation.
Purpose of the Study:
- To determine the diagnostic yield of routine infectious stool studies in pediatric UC patients.
- To assess the prevalence of various infections during UC flares.
Main Methods:
- Retrospective review of 152 pediatric UC patients.
- Analysis of infectious stool studies performed between January 2003 and December 2009.
- Data collection on test types, results, and patient records up to July 2014.
Main Results:
- Clostridium difficile was positive in 13.6% of 354 tests.
- Bacterial cultures were positive in 1.8% (non-typhoid Salmonella).
- Ova and Parasites were positive in 1.3%; Adenovirus PCR in 7.7%.
Conclusions:
- Routine Clostridium difficile screening is strongly recommended for pediatric UC flares.
- Other bacterial and parasitic infections are uncommon, but Salmonella warrants consideration.
- Non-specific fecal viral tests have questionable utility in UC patients without comorbidities.
Goals:
It can be important to exclude infectious etiologies prior to adjusting immunosuppressive therapy in patients with ulcerative colitis (UC) exacerbation. We sought to determine the diagnostic yield of routine infectious stool studies in pediatric UC patients.
Procedures:
We conducted a retrospective review of 152 pediatric UC patients at Texas Children's Hospital between January 2003 and December 2009. The patient records were followed through July 2014. The number and type of infectious stool studies performed and the results of those were collected.
Results:
Three hundred fifty-four diagnostic stool tests were conducted for Clostridium difficile; 13.6% were positive. Two hundred twenty stool bacterial cultures were performed, and 1.8% were positive, all growing non-typhoid Salmonella. One of 13 (7.7%) Adenovirus PCR tests was positive. Two of 152 examinations (1.3%) for Ova and Parasites were positive. No stool tests for viral culture, viral particles, Yersinia or Rotavirus were positive.
Conclusions:
Clostridium difficile infection is common in pediatric UC, and routine screening during flares is strongly recommended. Other bacterial and parasitic infections routinely tested for are uncommon, but Salmonella may be a potentially important attribute to disease exacerbations in select patients. In patients without co-morbid conditions, the utility of performing non-specific fecal viral tests is questionable.
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